Provider Demographics
NPI:1487753885
Name:C MALEKI MD INC
Entity type:Organization
Organization Name:C MALEKI MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COMRON
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-496-6611
Mailing Address - Street 1:2230 LYNN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1901
Mailing Address - Country:US
Mailing Address - Phone:805-496-6611
Mailing Address - Fax:805-494-6756
Practice Address - Street 1:2230 LYNN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1901
Practice Address - Country:US
Practice Address - Phone:805-496-6611
Practice Address - Fax:805-494-6756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36282207N00000X, 207ND0101X, 207ND0900X, 207NP0225X
COA36282207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Not Answered207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Not Answered207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Not Answered207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Single Specialty
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84870Medicare UPIN
CAS051522Medicare ID - Type Unspecified